BCA is dedicated to providing comprehensive compliance audit solutions tailored to the unique needs of healthcare professionals operating beyond the FQHC and RHC environments. Our expertise spans a multitude of specialty areas, ensuring thorough and meticulous evaluations that align with the latest healthcare regulations and best practices. We understand the intricacies of medical compliance and are committed to delivering audits that not only identify potential areas of risk but also foster an atmosphere of continuous improvement. Trust BCA to navigate the complexities of compliance with precision and professionalism.
BCA provides a comprehensive suite of compliance audit services tailored to support healthcare professionals in maintaining the highest standards of regulatory adherence. These services encompass a broad spectrum of areas, ensuring thorough coverage and peace of mind for all practitioners. BCA offers a diverse array of compliance audits to meet the needs of healthcare professionals which include but are not limited to:
- Family Practice
- Internist
- General Surgeon
- Podiatrist
- Orthopedic Surgeon
- Wound Care
- Hospitalist
- Behavioral Health Specialist
- Obstetrics and Gynecology
Common Challenges
- Understanding E&M Guidelines: Providers may lack current knowledge or training on how to apply the latest Evaluation and Management (E&M) coding guidelines, which can lead to incorrect billing and potential compliance issues.
- EMR Diagnosis Accuracy: Electronic Medical Records (EMR) systems may contain inaccurate or misleading diagnosis descriptions, which can compromise patient care and lead to billing errors.
- Balancing Competing Priorities: Healthcare providers often face the challenge of managing multiple priorities, from patient care to administrative tasks, which can impact efficiency and focus.
- Performance Metrics: Establishing and maintaining relevant performance metrics is crucial for providers to monitor and improve the quality of care, as well as to meet regulatory requirements.
- Risk Revalidation: Regular risk revalidation processes are essential to ensure that providers are adequately managing potential risks associated with patient care and healthcare operations.
- Navigating Value-Based Reimbursement: Transitioning to value-based reimbursement models requires a deep understanding of the metrics and strategies that drive quality care and cost efficiency.
- Continual Education and Training: Ongoing education and training for providers on these issues are vital for adapting to the evolving healthcare landscape and ensuring the highest standards of patient care.
Compliance Audits
- Ensuring Legal and Regulatory Adherence: Medical compliance audits are vital to ensure legal and regulatory requirements are met, thereby avoiding potential legal penalties.
- Quality of Care: Audits help maintain high standards of patient care by identifying areas of non-compliance and enabling healthcare providers to take corrective actions.
- Fraud and Abuse Prevention: Through regular compliance audits, organizations can prevent fraud and abuse, which is crucial for maintaining trust and integrity in healthcare services.
- Financial Health: Compliance audits can safeguard against financial risks by ensuring that billing and coding practices comply with current laws and regulations, which is essential for the financial sustainability of an organization.
- Performance Improvement: Regular audits provide an opportunity for continuous improvement in healthcare delivery and patient outcomes by identifying performance gaps and areas for enhancement.
- Resource Optimization: Audits can help optimize the use of resources by ensuring that services are appropriately utilized and documented.
Target Areas
- Documentation Review
- CPT, HCPCS, and ICD-10-CM Code Evaluation
- Service and Diagnosis Capture
- Medical Necessity Validation
- Documentation Specificity
- Trend Analysis
- Authentication Timeliness
- Claims Review
- NCCI Edits Application